I am a physician and behavioral scientist at Duke University. My research and writing explores the quirks in human nature that influence our lives — the mixture of rational and irrational forces that affect our health, our happiness and the way our society functions. (What fun would it be to tackle just the easy problems?) I am currently exploring controversial issues about the role of values and preferences in health care decision making, from decisions at the bedside to policy decisions. I use the tools of decision psychology and behavioral economics to explore topics like informed consent, shared decision making and health care spending. My books include Pricing Life (MIT Press 2000) and Free Market Madness (Harvard Business Press, 2009). My newest book, Critical Decisions (HarperCollins), explores the challenges of shared decision making between doctors and patients.

Does Health Insurance Improve Health? Evidence From Massachusetts

It is always important to remember that healthcare and health insurance are two very different things, and neither of them is a guarantee of good health. Therefore, when people talk about Obamacare providing people with medical care, we have to remember that it primarily provides people with health care insurance. And as I have written about previously, insurance coverage does not guarantee the receipt of quality healthcare, with many Medicaid recipients having a hard time finding doctors willing to see them.

Now comes a new study from Massachusetts, exploring whether expansion of health insurance within that state through Romneycare has improved the health of that state’s citizens. In the study, the researchers conducted a before/after look at the health of people in Massachusetts. The idea here is that if people’s health improves after they receive insurance coverage, that could result from the receipt of such coverage. Recognizing that other factors could also affect the health of people over time, the researchers also conducted a before/after look at other states in New England. The main idea here is simple: if over the same period of time, people in Massachusetts experience improvements in their health relative to their neighbors, we have evidence suggesting that the expansion of health insurance in Massachusetts benefited its citizens.

The answer? Across a number of measures, the researchers found relative improvements in the health of people in Massachusetts:

Keep in mind that these improvements are relatively small, and they aren’t always even improvements. In some cases they are smaller declines, but that’s not surprising given what has been happening to the economy over the same period of time. Bad economic circumstances tend to have a detrimental impact on people’s health.

People have criticized Romneycare and Obamacare for providing overly expansive insurance benefits. But one of the benefits of such benefits, if I can put it that way, is that it encourages people to receive important preventive services. Consider what happened to, among other things, colonoscopy rates in Massachusetts versus New England over this period of time:

Once again, the picture is complicated. Colonoscopy rates improved more in Massachusetts than other states, in part because Massachusetts started off underperforming.

Nevertheless, this study provides another bit of evidence about what happens when we make sure that people have affordable access to robust health insurance. It remains important for us to make sure that such insurance coverage does not lead healthcare costs to spiral out of control. In the meantime, however, we should not ignore the real benefits that accrue to people who receive affordable health insurance. Let’s keep that in mind as we go forward, and continue to reform our complicated healthcare system.

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